A new incision for unilateral cleft lip repair developed using animated simulation of repair on computer

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AK Sahay, R BharatDOI:10.4103/0970-0358.32655

Background: Unilateral cleft lip repair continues to leave behind some amount of dissatisfaction, as a scope for further improvement is always felt. Most surgeons do not like to deviate from the standard Millard's/ triangular techniques, or their minor modifications, as no one likes to experiment on the face for fear of unfavourable outcomes. The computer can be utilized as a useful tool in the analysis and planning of surgery and new methods can be developed and attempted subsequently with greater confidence.
Aim: We decided to see if an improved lip repair could be developed with the use of computers.
Materials and Methods: Analysis of previous lip repairs was done to determine where an improvement was required. Movement of tissues, by simulating an ideal repair, using image warping software, on digital images of cleft lip was studied in animation sequences. A repair which could reproduce these movements was planned.
A new incision emerged, which had combined the principles of Millard's and Randall / Tennyson repairs, with additional features. The new method was performed on 30 cases.
Conclusions: The results were encouraging as the shortcomings of these methods were minimized, and the advantages maximized.

Management of unresolved hemangiomas and venous malformations is a real challenging problem because of their grotesque nature and aesthetic considerations. In our study we have used percutaneous injection of N-butyl cyanoacrylate (NBCA) in such lesions to make these lesions amenable to easy excision. When the NBCA comes in contact with tissue fluid, it causes intercompartmental tissue adhesion, thus there is cessation of blood flow into the vascular malformation tissue. After few injections the whole mass forms a solid polymer, which is then excised. During excision there is remarkably minimum bleeding. In small lesions, per-operative injection just prior to surgery was also done.

Background: Reconstruction of soft tissue defects around the wrist with exposed tendons, joints, nerves and bone represents a challenge to plastic surgeons, and such defects necessitate flap coverage to preserve hand functions and to protect its vital structures. We evaluated the use of a distally-based island ulnar artery perforator flap in patients with volar soft tissue defects around the wrist.
Materials and Methods: Between June 2004 and June 2006, seven patients of soft tissue defects on the volar aspect of the wrist underwent distally-based island ulnar artery perforator flap. Out of seven patients, five were male and two patients were female. This flap was used in the reconstruction of the post road traffic accident defects in four patients and post electric burn defects in three patients. Flap was raised on one or two perforators and was rotated to 180º.
Results: All flaps survived completely. Donor sites were closed primarily without donor site morbidity.
Conclusion: The distally-based island Ulnar artery perforator flap is convenient, reliable, easy to manage and is a single-stage technique for reconstructing soft tissue defects of the volar aspect of the wrist. Early use of this flap allows preservation of vital structures, decreases morbidity and allows for early rehabilitation.

Background: Displaced fractures of the zygomatic bone can result in significant functional and aesthetic sequelae. Therefore the treatment must achieve adequate and stable reduction at fracture sites so as to restore the complex multidimensional relationship of the zygoma to the surrounding craniofacial skeleton. Many experimental biophysical studies have compared stability of zygoma after one, two and three-point fixation with mini plates. We conducted a prospective clinical study comparing functional and aesthetic results of two-point and three-point fixation with mini plates in patients with fractures of zygoma.
Materials and Methods: Twenty-two patients with isolated zygomatic fractures over a period of one year were randomly assigned into two-point and three-point fixation groups. Results of fixation were analyzed after completion of three months. This included clinical, radiological and photographic evaluation.
Results: The three-point fixation group maintained better stability at fracture sites resulting in decreased incidence of dystopia and enophthalmos. This group also had better malar projection and malar height as measured radiologically, when compared with the two-point fixation group.
Conclusion: We recommend three-point rigid fixation of fractured zygoma after accurate reduction so as to maintain adequate stabilization against masticatory forces during fracture healing phase.

Bacterial isolates from burn wound infections and their antibiograms: A eight-year study

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Manjula Mehta, Priya Dutta, Varsha GuptaDOI:10.4103/0970-0358.32659

Background: Infection is an important cause of mortality in burns. Rapidly emerging nosocomial pathogens and the problem of multi-drug resistance necessitates periodic review of isolation patterns and antibiogram in the burn ward.
Aim: Keeping this in mind, the present retrospective study from wounds of patients admitted to burns unit was undertaken to determine the bacteriological profile and the resistance pattern from the burn ward over a period of three years (June 2002 to May 2005) and was compared with the results obtained during the previous five years (June 1997-May 2002), to ascertain any change in the bacteriological profile and antimicrobial resistance pattern.
Materials and Methods: Bacterial isolates from 268 wound swabs taken from burn patients were identified by conventional biochemical methods and antimicrobial susceptibility was performed. Statistical comparison of bacterial isolates and their resistance pattern with previous five years data was done using c2 test.
Results and Conclusions: During the period from 2002 to 2005 Pseudomonas species was the commonest pathogen isolated (51.5%) followed by Acinetobacter species (14.28%), Staph. aureus (11.15%), Klebsiella species (9.23%) and Proteus species (2.3%). When compared with the results of the previous five years i.e., 1997 to 2002, Pseudomonas species was still the commonest pathogen in the burns unit. However, the isolation of this organism and other gram-negative organisms had decreased in comparison to previous years. Newer drugs were found to be effective.

Objectives: Unlike most other Analgesic drugs, α2 adrenoceptor agonists are capable of producing analgesia. The aim of this study was to evaluate the Analgesic and antisympathetic effects of clonidine, an α2 adrenoceptor agonist in burn patients.
Materials and Methods: This randomized, double-blind, placebo-controlled clinical trial performed on one hundred burn patients in Zarea Hospital, Mazandaran, Iran from august 2004 to July 2005. All patients divided in two groups. Case group (n=50) received oral clonidine, 3.3μg/kg TDS and controls (n=50) received placebo. Heart rate and systolic blood pressure and pain severity Visual analogue score (VAS), were recorded after clonidine administration. Statistical analysis was done by means of Mann Witney U test.
Results: 50 patients (mean age 28.96±10 years) in case group, and 50 patients (mean age 27.60±11.4 years) in control group were studied. VAS pain scores and heart rate in the clonidine group were significantly lower than the control group (P<0.0001, P<0.02).there were no significant difference in systolic blood pressure between the two groups on the first and second day but on third day the systolic blood pressure in clonidine group, was lower than controls significantly (P=0.002).
Conclusion: This study demonstrates that the use of oral clonidine affects the hemodynamic response to pain in burn patients. Our study demonstrated that clonidine can produce good analgesia and decreased in sympathetic over activity in burn patients, and also reduce opioid dose requirements.

Repair of large urethrocutaneous fistula with dartos-based flip flap: A study of 23 cases

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Ashutosh Soni, Sanjay SheoranDOI:10.4103/0970-0358.32661

The commonest complication of hypospadias repair is occurrence of urethrocutaneous fistulae. These fistulae may be caused by a variety of factors and occur in different sizes at various sites of the previous repair. Small fistulae are easier to close with local tissue and flaps but larger fistulae which are 4 mm or more in size are difficult to close because of the paucity of available tissues and chances of recurrence. A variety of methods have been described in the literature for the repair of urethrocutaneous fistulae with variable results. In this study of 23 cases, we have successfully repaired large urethrocutaneous fistulae using dartos-based flip flaps for their closure in the period from June 2001 to May 2006. These flaps can cover any fistulae from the penoscrotal region to the distal penile shaft. Dartos-based flip flaps are robust and vascularized and provide watertight closure and at the same time they are easy to elevate and leave no residual donor site morbidity.

Aims and Objectives: Shoulder stability and restoration are very important in providing greater range of motion to the arm and forearm. When brachial plexus repair does not have the desired outcome and in patients with long standing denervation, the trapezius muscle is frequently used for transfer to restore the shoulder abduction and external rotation. We propose a modified simple technique for trapezius muscle transfer.
Materials and Methods: From February 2004 to February 2006, eight patients with posttraumatic brachial plexus injury with insufficient shoulder abduction were treated by trapezius muscle transfer. All patients with brachial plexus palsy were posttraumatic, often resulted from motor cycle accidents. Before operation a full evaluation of muscle function in the affected arm was carried out. All patients were treated with trapezius muscle transfer performed by the modified technique. S-shaped incision from the anterior border of the trapezius just above the clavicle to the Deltoid up to its insertion was made. The accessory nerve and its branches to the trapezius were secured. The trapezius was dissected and detached from its insertion along with the periosteum and sutured to the insertion of the Deltoid muscle.
Results: All patients had improved functions and were satisfied with the outcome. The average increase in active abduction of shoulder was from 13.7 degrees (0 to 35 degrees) preoperatively to 116 degrees (45 to 180 degrees) postoperatively and of shoulder flexion from 24.3 degrees (15 to 30 degrees) to 107 degrees (90 to 180 degrees).
Conclusion: The modified technique proposed here for trapezius transfer is safe, convenient, simple and reliable for restoration of shoulder abduction and stability with clear subjective benefits.

Background: Pilonidal sinus is a common disease in young adults that carries high postoperative morbidity and patients' discomfort; controversy still exists regarding the best surgical technique for the treatment of the disease. We successfully treat it with a rotation flap technique (simple rotation and bilobed rotation flap).
Materials and Methods: Sixty-two patients were randomized to receive surgical treatment in the form of either simple rotation or bilobed rotation flap by eccentric elliptical excision of the diseased tissues down to the sacral fascia and closure of the defect with the flap, then placing a closed suction drain at the base of the wound, with its tip being brought out in the gluteal region at least 5 cm laterally to the lower end of the suture.
Results: All our patients healed completely without recurrence after a mean follow-up of about one year. Mean hospital stay 1.5 days (range 1-3) Mean time to complete healing 11.9 days (range 8-14). Mean time off work was 11.5 days (range 10-21), wound infection and breakdown, three (4.8%), recurrence (0%), and time to sitting on the toilet and walking without pain was 10-15 days.
Conclusions: A tension-free suture and cleft left via the rotation flap, either the bilobed flap or monolobed, is the key to success without recurrence and low patient discomfort.

We report a rare case of internal maxillary artery pseudoaneurysm in a patient with a subcondylar fracture of the mandible. Though traumatic pseudoaneurysm in the craniofacial region is a known entity, a situation in which a closed mandibular fracture presents as a rapidly growing swelling in the neck and facial region is a rare presentation. Such a warning sign should be taken seriously and investigated further.

An arteriovenous fistula secondary to a chalazion is a rare occurrence. It may follow spontaneous necrosis or surgical trauma. Digital subtraction angiography and identification of the arterial feeders combined with direct puncture of the nidus and embolization is recommended, as surgical excision becomes much easier and results in a complete excision of the lesion. Conchal cartilage graft is a useful lining material for reconstruction of the tarsal plate due to its natural curvature. It restores lid integrity and ensures a stable and functional eyelid.

Group 30 cleft of Tessier classification of craniofacial clefts is supposedly one of the rarest clefts seen. This case presented in a most interesting and bizarre fashion - a neck swelling becoming prominent on coughing. The associated finding was even more amazing and rare - a congenital foregut duplication cyst in the neck. We proceed to discuss the rarity of such a case and the possibility of this being one of first few of its kind.

Background: Giant cell tumor is a fairly common locally invasive tumor in young adults. The lower end of the radius is the second commonest site for this tumor. The most common treatment for this tumor is curettage with or without bone grafting but it carries a significant rate of recurrence. Excision is the treatment of choice, especially for cases in which the cortex has been breached. After excision of the distal end of the radius, different procedures have been described to reconstruct the defect of distal radius. These include partial arthrodesis and hemiarthroplasty using the upper end of the fibula. The upper end of the fibula has a morphological resemblance to the lower end of the radius and has been used to replace the latter. Traditionally it was used as a 'free' (non-vascularized) graft. More recently the upper end of the fibula has been transferred as a vascularized transfer for the same purpose. Though vascularized transfer should be expected to be more physiological, its superiority over the technically simpler non-vascularized transfer has not been conclusively proven.
Materials and Methods: Two patients are presented who had giant cell tumor of distal radius. They underwent wide local excision and reconstruction with free vascularized upper end of the fibula.
Result: Follow-up period was two and a half years and 12 months respectively. Both patients have returned to routine work. One patient has excellent functional result and the other has a good result.
Conclusion: Vascularized upper end of fibula transfer is a reliable method of reconstruction for loss of the distal end of the radius that restores local anatomy and physiology.

Context: Bipolar cautery forceps are an expensive instrument and especially in Government Medical colleges and Government Hospitals, getting a pair is a very tedious and prolonged task due to official reasons.
Aims: To make a cheap and easily obtainable bipolar cautery forceps.
Settings and Design: The reason for innovation was that the cautery forceps in the department were out of order and we were not getting replacements.
Materials and Methods: Made from condemned and damaged forceps or from stainless steel nonsurgical forceps which are very low-cost, very cheap and easy to get hold of, especially in a Government institution with limited resources.
Results: It has been used for the past one and a half years in our Department for plastic surgical procedures, including microvascular surgery. Initially, it was designed when the cautery forceps in the department were out of order and we were not getting replacements and later on, it became part of the routine set as it was found to be equally good.
Conclusions: A very cheap and useful alternative to the commercially available bipolar cautery forceps has been made.